Carbapenem-resistant Klebsiella pneumoniae gut colonization and subsequent infection in pediatric intensive care units in shanghai, China

BackgroundIt has been revealed that carbapenem-resistant Klebsiella pneumoniae (CRKP) colonization is closely associated with subsequent clinical infections. This study aimed to investigate the resistance and epidemiology of CRKP isolated from anal swabs and subsequent clinical infection specimens in two pediatric intensive care unit (ICU) departments. Clinical characteristics were analyzed to identify the risk factors of CRKP infection.MethodsA 3-year retrospective study was carried out in pediatric intensive care units (PICU) and neonatal intensive care units (NICU). CRKP isolates from colonization and infection samples were characterized by testing resistance genes and multilocus sequence typing (MLST). The results of MLST were analyzed to derive CCs by Bionumeric 8.0. Clinical variables such as gestational age, birth weight, mode of delivery, underlying diseases, exposure of antimicrobial agents, history of surgery, length of hospital stay, and prognosis were collected through the electronic medical record system and analyzed by SPSS 22.0.ResultsOf the 2225 patients who were screened for CRE colonization, 7.42% of patients were detected positive. The incidence of subsequent infection was 18.18%. Carbapenemase genes blaKPC-2 and blaNDM-1 were the most prevalent in the colonization and infection of CRKP. The majority of CRKP isolated from anal swabs and infection samples belonged to CC11/ST11. The distribution of CC11 in the PICU was significantly higher than in NICU. ST11/blaKPC-2 was significantly higher in infection CRKP isolates. Age older than one year and usage of carbapenems within 3 months prior to detection of CRKP colonization were independent risk factors for CRKP clinical infection.ConclusionThe main prevalence of CRKP varies in different departments. Colonization of ST11/blaKPC-2 CRKP may increase the incidence of subsequent infections in pediatric ICU patients. Age and usage of carbapenems could increase the risk of CRKP infection in this study.